Iranian Journal of Pediatric Hematology and Oncology
Volume:9 Issue: 2, Spring 2019

Hyperglycemia is one of the most complications of corticosteroid and asparaginase during induction phase of chemotherapy in children suffering from acute lymphoblastic leukemia (ALL). This study was carried out to evaluate the incidence of hyperglycemia and associated risk factors during chemotherapy induction phase at Amirkola Children's Hospital. In this cross-sectional (retrospective) study, 150 children (mean age: 79.16±42.68 months) with ALL were evaluated (2000- 2011). Hyperglycemia was described as random blood glucose level more than 200mg/dl in patients less than 2 years old. In patients older than 2 years, fasting blood glucose level more than 110-125 mg/dl was considered as impaired glucose level and fasting blood glucose level more than 126 mg/dl was defined as diabetes mellitus. The data were analyzed using SPSS (version 18) and running chi square test, pearson Ccorrelation, and logistic regression. P-values less than0.05 was considered statistically significant. Out of 150 children with ALL, 21 (14%) of them had hyperglycemia, but none of them had diabetic ketoacidosis. Hyperglycemia was significantly associated with gender (P=0.014) and age. (P=0.000) which was more likely in patients older than 10 years. The incidence of hyperglycemia was also related to BMI (P=0.000). Relapse rate for ALL was 14.7%, which was not significantly associated with hyperglycemia. Hyperglycemia was common and transient during induction phase of chemotherapy and it was correlated with age, sex, and weight.

Children with acute lymphoblastic leukemia (ALL) are prone to neurotoxicity and consequently neurocognitive function impairment mainly due to undergoing different treatment modalities. In the current investigation, neurocognitive function of children with ALL was compared to that of healthy children. In this cross-sectional study, 155 ALL and 155 age- matched healthy children in Shiraz, Southern Iran, were included and evaluated using Continuous Performance Test (CPT).  Mean age of the patients was 9.9± 2.4 years. The number of wrong responses and duration of response did not lead to significant difference between healthy and affected children. In the age group less than 12 years old, the frequency of no-response was higher in the case group compared to control group both in boys and girls (P = 0.012, P = 0.006 respectively). In addition, in male patients younger than 12 years old, the number of correct responses was significantly less than that of  controls (P = 0.010). Patients underwent concurrent radiotherapy and chemotherapy needed significantly more time for responding compared to patients in whom chemotherapy were discontinued and were in remission (P=0.001). Based on the results, ALL children younger than 12 years old showed some defects in cognitive function. Moreover, it was more prominent in young boys compared to young girls. Regardless of the type of treatment regimens, early detection of neurocognitive disorders should be warranted in this high-risk population with more focus on boys and younger children. Psychological support and appropriate interventions can help improve cognitive function, reduce the disruption of education, and enhance the social and family relationships.

DNA molecule of the eukaryotic cells is found in the form of a nucleoprotein complex named chromatin. Two epigenetic modifications are critical for transcriptional control of genes, including acetylation and DNA methylation. Hypermethylation of tumor suppressor genes is catalyzed by various DNA methyltransferase enzymes (DNMTs), including DNMT1, DNMT2, and DNMT3. The most well characterized DNA demetilating and histone deacetylase inhibitor drugs are 5-aza-2ˈ-deoxycytidine (5-Aza-CdR) and valproic acid (VPA), respectively. The purpose of the current study was to analyze the effects of 5-Aza-CdR and VPA on cell growth, apoptosis, and DNMT1 gene expression in the WCH-17 hepatocellular carcinoma (HCC) cell line. In this descriptive analytical study, MTT assay, flow cytometry assay, and Quantitative Real-Time RT-PCRwere done to evaluate proliferative and apoptotic effects and also gene expression. Both compounds inhibited the cell growth and induced apoptosis significantly in a dose and time depended fashion. Additionally, 5-Aza-CdR down-regulated DNMT1 gene expression. The relative expression of DNMT1 was 0.40 and 0.20 (P < 0.001) at different times, respectively. The percentage of VPA- treated apoptotic cells were reduced by about 28 and 34 % (P˂0.001) and that of 5-Aza-CdR-treated were reduced by about 34 and 44 % (P˂0.001) after treatment time periods. In the current study, it was observed that 5-Aza-CdR and VPA could significantly inhibit the growth of WCH-17 cell and played a significant role in apoptosis. It was also found that 5-Aza-CdR could decrease DNMT1 gene expression.

Infant jaundice is one the most common causes of hospitalization in infant in the first month of birth, which is defined an abnormal increase in blood bilirubin levels. Exchange transfusion is the recommended treatment for neonatal jaundice who do not respond to phototherapy and experience dangerous complication of jaundice and signs of kernicterus. However, this treatment may lead to complications such as thrombocytopenia. This study aimed to investigate the severity and duration of thrombocytopenia following the exchange transfusion in neonatal jaundice. Material and This cross section study was performed on 217 infants. Infants with a gestational age of 35 to 42 weeks and bilirubin levels of above 17 mg/dl, who were undergoing treated with exchange transfusion, entered in this study. This study was conducted from 2012 to 2018 in the Ghaem Hospital (Mashhad, Iran). The samples were selected by convenience sampling. The platelet count was measured before exchange transfusion, right after exchange transfusion, 6 hours after exchange transfusion, and platelet count continued until platelet level was normal.  At the time of discharge, platelet levels were re-measured. Among the samples, 104(53.8%) were males and 89 (46.2%) females. Of the infants who were transfused, 15 % had thrombocytopenia. After the exchange transfusion, 80 % of infants had thrombocytopenia. The mean platelet count before the exchange transfusion was 299,180 per mm3 of blood, and it was 105.140 per mm3 of blood after the exchange transfusion. With respect to severity of this complication, 86 % of the thrombocytopenia after exchange transfusion was mild to moderate. In this study, nearly one-sixth of the infants who needed exchange transfusions had thrombocytopenia that most of them had platelet of more than 100000.  Thrombocytopenia is associated with jaundice and can be exacerbated by phototherapy.

Red blood cells transfusion is a useful practice for preterm infants. Large amount of blood is usually wasted in the infants. Considering that few studies have been carried out on infants, the aim of current study was to investigate the frequency of packed red blood cells transfusion in preterm infants admitted to NICU of Shahid Sadoughi Hospital in Yazd during 2016 This retrospective descriptive-analytical study was conducted on infants admitted to Neonatal intensive care unit (NICU) of Shahid Sadoughi Hospital, Yazd, Iran during 2016. Variables including fetal age, sex, birth weight, delivery method, Apgar score, infant status, premature birth complications and transfusion information were extracted from medical records of patients. Current study was conducted on 335 premature infants. Among them, 85 cases were received packed red blood cells transfusion (25.4%). Of the infants receiving packed red blood cells, 59 cases (69.4%) were alive and 26 (30.6%) dead. Distribution of preterm complications in infants including respiratory distress syndrome, sepsis, respiratory failure and Pneumothorax was observed in 66 (77.6%), 19(22.4%), 52(61.2%) and 14 patients (16.5%), respectively. There was significant difference between mean age and mean Apgar score in terms of transfusion (p<0.01). The mean volume of consumed blood was 34.20 ± 27.44 ml. The mean volume of wasted blood was 488.39±355.88 ml. Minimum and Maximum volume of wasted blood was 220 and 1873 ml. According to results of current study, the mean age and mean Apgar score in patients undergoing transfusion was lower than those did not have transfusion. Moreover, total volume of wasted blood was 14.2 times more than consumed blood. Therefore, optimal usage of blood products and the use of smaller blood bags are proposed in order to improve the health of infants in intensive care units and lessen complications of blood transfusion in newborns.

Storage of platelet concentrates (PCs) at room temperature (20-24°C) limits its storage time to 5 days due to the destructive effects of platelet storage lesion (PSL) and bacterial contamination. Although prolonged storage of platelets (PLTs) at 4°C reduces the likelihood of bacterial contamination and PSL levels, it is accompanied by an increase in the clearance rate and changes in the surface markers of PLTs. The goal of this study was to evaluate the effects of sodium octanoate (SO) as a stabilizer on PLTs during storage at 4°C. In this experimental study, PCs were divided into three portions and stored for 5 days at 3 different conditions, including 20-24°C, 4°C temperature, and 4°C in presence of SO. PLTs enumeration was performed using an automated hematology analyzer. To measure the metabolic activity and survival rate of PLTs, the water-soluble tetrazolium salt (WST-1) assay was performed. The activity of lactate dehydrogenase enzyme (LDH) was measured by a biochemical analyzer. Additionally, the levels of PLT glycoprotein Ibα (GPIbα) and CD62P (P-selectin) were measured on PLTs by flow cytometry technique. PLTs count was higher in SO-treated (4°C) PLTs than two other studied samples. Additionally, the viability was higher in the SO-treated PLTs than that in other groups. LDH amount was lower in the SO-treated PLTs than that in other groups (P>0.05). GPIbα expression was significantly higher in SO-treated PLTs than that other groups (P0.05). SO could modulate the effects of cold temperatures on PLTs. Furthermore, we found that the survival of platelets was better maintained in the presence of SO at 4°C.

Induced pluripotent stem cells (iPSCs) are reprogrammed from somatic cells through numerous transcription factors. Human induced pluripotent stem cell approaches are developing as a hopeful strategy to improve our knowledge of genetic association studies and the underlying molecular mechanisms.  Rapid progression in stem cell therapy and cell reprogramming provides compelling reasons for its feasibility for treating a wide range of diseases through the replacement of autologous cells. Continuous failure in embryonic stem cells (ESC) production and the dependency of iPSC on ectopic genes may be due to the inability to maintain the stability of the endogenous gene systems which are essential for creation of pluripotency state. With recent developments in the genome processing and human tissue culturing approaches as well as xenotransplantation, bioengineering, and genome editing, induced pluripotent stem cells offer the new opportunities for the study of human cancers. Most hematopoietic malignancies are originated from cells that are functionally heterogeneous and few of them are responsible for maintaining tumor state. The naming of these cancer stem cells are due to the quality characteristics of normal tissue stem cells, such as self-renewal, long term survival, and the ability to produce cells with more differentiated properties. The aim of present study was to focus on the recent progresses in the application of stem cell-based hematopoietic cancer, and to assess the benefits of treatment, opportunities, and shortcomings that can potentially help improve future efforts in experimental and clinical studies.

Brain tumors are the most common solid tumors in childhood. Glioblastoma multiform (GBM) is the second most common primary brain tumor in adults. It usually affects the cerebral hemispheres of adults at the 6th or 7th decade of life. In comparison to adult population, GBM is rare in pediatrics and accounts for approximately 3% of all pediatric brain tumors. Pediatric glioblastoma was defined as patient age younger than 21 years at the time of craniotomy. The prognosis seems to be better in childhood. This report documented a GBM was located in the frontal lobe of a 9 year old girl who was diagnosed in Hamedan University of Medical Sciences in 2016. Magnetic resonance imaging (MRI) showed a huge well enhancing mass in left frontal lobe (47 ×35 mm ). This mass was surrounded by vasogenic edema and was extended to medial aspect of right frontal lobe through corpus callosum. The patient underwent a left frontal craniotomy, and gross total tumor removal was per formed. Pathology findings revealed neoplastic transformation of glial cells associated with vascular necrosis and neovascularization.